Summary of Findings
The 2003 National Demographic and Health Survey (NDHS) is a nationally representative survey of 13,945 women age 15-49 and 5,009 men age 15-54. The main purpose of the 2003 NDHS is to provide policy makers and program managers with detailed information on fertility, family planning, childhood and adult mortality, maternal and child health, knowledge and attitudes related to HIV/AIDS and other sexually transmitted infections. The 2003 NDHS also collects high quality data on family health: immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery and breastfeeding.
The 2003 NDHS is the third national sample survey undertaken in the Philippines under auspices of the worldwide Demographic and Health Survey program.
The 2003 NDHS indicates that there has been a steady declined in fertility in the Philippines in the past three decades from 6.0 children per woman in 1970 to 3.5 children per woman in 2001. However, compared with current fertility levels in Southeast Asia, fertility in the Philippines is relatively high. Only the levels of Laos (4.7 children per woman) and Cambodia (4.0 children per woman) are higher.
Fertility varies substantially across sub groups of women. Urban women have, on average, 1.3 children fewer than rural women (3.0 and 4.3 children per woman, respectively). The differences are also substantial across regions. The National Capital Region (NCR) has the lowest fertility rate (2.8 children per woman) while MIMAROPA has the highest (5.0) children per woman).
Fertility level has a negative relationship with education. The fertility rate of women with college or higher education (2.7 children per woman ) is about half that of women with no education (5.3 children). Fertility is also negatively associated with wealth index quintile: women in wealthier households have fewer children than those in poorer households.
WHY DID FERTILITY DECLINE
The decline in fertility is brought about by, among other things, longer birth intervals, and desire for fewer children.
Longer birth intervals. Fertility decline in the Philippines can be attributed to longer intervals between births. Results of the 2003 NDHS indicate that half of births occur 30.5 months after the previous birth, which is longer than the median birth interval reported in the 1998 NDHS (28 months).
Gap between wanted fertility and actual fertility rates. Despite increasing use of contraception, the survey data indicate that one in four pregnancies is mistimed and one in five is not wanted at all. If unwanted births could be prevented, the total fertility rate in the Philippines would be 2.5 births per woman instead of the actual level of 3.5. This gap between wanted fertility and actual fertility is the same as that observed in the 1998 survey, but the fertility levels in 2003 are lower than in 1998 (2.7 and 3.7 births per woman, respectively).
Increased use of contraception. Contraceptive use among currently married women in the Philippines over the past 35 years has more than tripled, from 15 percent in 1968 to 49 percent in 2003. Most of the rise in contraceptive prevalence is due to the increase in the use of modern contraceptive methods, from 25 percent in 1993 to 33 percent in 2003.
USE OF CONTRACEPTION
Method mix. Not only has the contraceptive prevalence rate in the Philippines increased, the proportion of married women who use modern contraceptive methods has increased from 28 percent in 1998 to 33 percent in 2003, while use of traditional methods has decreased from 18 percent in 1998 to 16 percent in 2003.
Large differential in use of contraception. There are large differences in the use of modern contraceptive methods across subgroups of married women. More than half of women with at least a high school education are current users of contraception compared with less than one in five women with no formal education.
Use of any method of family planning also increases with wealth status. Contraceptive prevalence is 37 percent among women in the lowest wealth quintile, 54 percent of those in the fourth quintile, and 51 percent for women in the highest wealth quintile.
Contraceptive use shows an inverted U-shaped relationship with the number of living children. Use of any method ranges from 6 percent among women with no living children to 61 percent for women with three to four children, after which it declines to 46 percent for women with five or more children.
Contraceptive prevalence among married women by region ranges from 19 percent in ARMM to 59 percent in Davao Peninsula. However, use of modern methods shows a different pattern. The proportion of currently married women who use modern methods of contraception is 40 percent or more in Central Luzon. Davao, and Cagayan Valley, and only 12 percent in ARMM. Traditional methods are most popular in Bicol Region (24 percent) and least popular in Cagayan Valley (4 percent).
Source of supply. Over two-thirds of current users of modern methods obtain their contraceptive supplies and services from a public source (67 percent), 29 percent from a private medical source, and 3 percent from other sources. Compared with data from the 1998 NDHS, there has been a decrease in reliance to the public sector (from 72 percent) and an increase in use of private sector (from 26 percent).
Unmet need for family planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2003 NHDS data show that the total unmet need for family planning in the Philippines is 17 percent, of which 8 percent is for limiting and 9 percent is for spacing. The level of unmet need has declined from 20 percent in 1998.
Overall, the total demand for family planning in the Philippines is 69 percent, of which 75 percent has been satisfied. If all of this need were satisfied, a contraceptive prevalence rate of about 69 percent could, theoretically, be expected. Comparison with the 1998 NDHS indicates that the percentage of demand satisfied has increased only slightly from 72 percent.
Antenatal Care Nine in ten mothers received care from medical professional during their pregnancy; 50 percent received care from a nurse or a midwife and 38 percent from a doctor. Traditional birth attendants provide antenatal care to 7 percent of women. Six percent of pregnant women received no antenatal care. These figures show little change from those recorded in the 1998 NDHS.
The Philippines Department of Health (DOH) recommends that all pregnant women have at least four antenatal care visits during each pregnancy. The 2003 NDHS data show that seven in ten women with a live birth in the five years before the survey had the recommended number of antenatal care visits during the pregnancy for the last live birth.
The DOH further recommends that for early detection of pregnancy-related health problems, the first antenatal check up should occur in the first trimester of the pregnancy. More than half (53 percent) of women who had at least one live birth in the five years before the survey adopt this recommendation. For three in ten women, the first visit was made when their pregnancy was 4-5 months, while one in 10 had the first antenatal care when they were 6-7 months pregnant.
Information about the danger signs of pregnancy. Five in ten of women with live birth in the five years preceding the survey were informed about the danger signs of pregnancy complications. This is an increase from 33 percent in 1998.
Tetanus toxoid injections. The DOH also recommends that women receive at least two tetanus toxoid (TT) injections during their first pregnancy. The 2003 NDHS shows that 37 percent of women who had a live birth in the five years before the survey met this recommendation. TT coverage in 2003 is similar to that recorded in the 1998 NDHS (38 percent).
Delivery care. Thirty-eight percent of live births in the five years before the survey were delivered in a health facility and 61 percent were born at home. These figures show an increase in proportion of births occurring in a health facility from 34 percent in 1998 and a decline in percentage of births delivered at home (66 percent in 1998).
Assistance during delivery Six in ten births in the five years before the survey were assisted by health professionals; 34 percent by a doctor and 26 percent by a midwife or a nurse. While coverage of births attended by a health professional has increased in the last five years from 56 percent in 1998, it remains lower than the target set by DOH (80 percent by 2004).
Postnatal care. The DOH recommends that mothers receive a postpartum checkup within two days of delivery. Women who delivered in a health facility are assumed to receive post natal care. One in three women who delivered outside a health facility had their first postnatal checkup within two days of delivery. With another 17 percent of women receiving their first postnatal checkup from 3 to 6 days after delivery, 51 percent of women received a postnatal checkup within six days of delivery. Combined with 38 percent of women delivering their last birth in a health facility, a total of 89 percent of women received postnatal care in the 6 days after delivery. This percentage is higher than the target set by the DOH (80 percent).
Childhood immunization. Information from health cards and mothers' reports (combined) shows that 60 percent of children 12-23 months have been immunized with vaccines against the six preventable childhood diseases - tuberculosis, diphtheria, pertussis, tetanus, polio, and measles-before one year of age. Seventy percent of children age 12-23 months have received the vaccines. This rate is higher than in the 1998 NDHS (65 percent). The proportion of children age 12 to 23 months who have received no vaccination (7 percent) is similar to that in the 1998 NDHS (8 percent).
Childhood illnesses. Acute respiratory infection (ARI), diarrhea, and malaria are common causes of childhood illness and death. In the 2003 NDHS, acute respiratory infection was identified by mother's reports on the prevalence of symptoms of ARI-cough accompanied by short, rapid breathing-in the two weeks preceding the survey. One in ten children under age five had symptoms of ARI.
Eleven percent of children under age five were reported to have diarrhea during the two-week period before the survey, which indicates a slight increase from the 7 percent level in the 1998 NDHS.
Thirty-two percent of children who were reported to have had diarrhea were taken to a health facility for treatment. Fifty-nine percent of children with diarrhea were treated with ORT, either ORS packets (42 percent), recommended homemade fluids (RHF) (24 percent), or increased fluids (2 percent). Other treatments for diarrhea were pills or syrup (30 percent), a home remedy (18 percent), injection (1 percent), or intravenous solution (1 percent).
Breastfeeding. The prevalence of breastfeeding in the Philippines has remained the same, at least since the 1993 survey. Eighty-seven percent of children born in the five years preceding the 2003 NDHS were breastfed. There has been no change in this practice since 1993 (87 percent in 1993 and 88 percent in 1998). Overall, the most common reason given by mothers for not breastfeeding their babies is that they do not have enough milk (20 percent), that they have nipple or breast problems, or that they are working (5 percent and 13 percent respectively). Twelve percent of mothers reported that the child refused to be breastfeed.
The median duration of any breastfeeding, increased from 12.8 months in 1998 to 14.1 months in 2003. However, the median duration of exclusive breastfeeding declined slightly from 1.4 months in 1998 to 0.8 months in 2003.
Perceived problems in accessing health care. In the 2003 NDHS, women were asked whether they have problems seeking medical advice or treatment for themselves. Getting money for treatment is the problem most often cited (67 percent). Other problems include not wanting to go alone (28 percent), access to the health facility because of the distance (27 percent), and because they have take transport to go to the health facility (26 percent).
AWARENESS OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS
Knowledge of HIV/AIDS and ways to avoid HIV/AIDS/STIs. While the vast majority of the 2003 NDHS respondents have heard of AIDS (95-96 percent), knowledge of the three principal ways to reduce HIV transmission-abstinence, use of condoms, and reducing the number of partners-is not widespread. Less than half of women and 62 percent of men know that HIV can be prevented by using condom, 77 percent of women and men say that limiting sex to one uninfected partner can reduce the risk of getting HIV. Forty-five percent of women and 56 percent of men know that the combination of the two preventive measures can reduce the risk of HIV infection.
Misconceptions about the transmission of AIDS are high in the Philippines; only 36 percent of women and 30 percent of men reject the two most common misconceptions about AIDS in the Philippines (i.e., AIDS can be transmitted by mosquito bites and by supernatural means).
Knowledge of mother-to-child transmission (MTCT). In the 2003 NDHS respondents were asked if the virus that causes AIDS can be transmitted from a mother to child. The general knowledge about HIV transmission during pregnancy, delivery, and breastfeeding is relatively high (63 to 73 percent among women and 60 to 80 percent among men). However, few women and men (20 to 21 percent) know that the risk of MTCT can be reduced if a mother takes special drugs during pregnancy. This knowledge varies widely across subgroups of women and men. Urban residence, education, and household economic status have a positive impact on the respondent's knowledge of MTCT.
Stigma and Discrimination Associated with HIV/AIDS. The majority of respondents (76 percent of women and 79 percent of men) feel that HIV-positive status should not be kept confidential. When asked if they would be willing to care for a relative who became sick with AIDS in his/her own household, 34 percent of women and 29 percent of men gave a positive response. To asses whether there is a discrimination against persons with AIDS in the workplace, the respondents were asked if they believe that an HIV-infected female teacher should be allowed to continue teaching. Only a small percentage (14 percent of women and 11 percent of men) agreed with the question.
Self-reporting of sexually transmitted infections (STIs). Less than 2 percent of men reported having had an STI and/or symptoms of an STI in the 12 months preceding the survey. However, less than half of the men sought care (46 percent) for the infection.
Men having sex with men. Among men who have ever had sex, 5 percent reported ever having had sexual relations with a man; less than 1 percent reported having sex with a man in the 12 months preceding the survey. Nonmarried men and men with high school education are more likely to engage in homosexual relations than other men.
Knowledge of tuberculosis (TB). Almost all of the women and men surveyed (97 percent of women and 96 percent men) have heard of TB. However, the percentage of respondents who believe that TB can be cured is a little lower (92 percent for women and 89 percent for men). About half of the respondents know that TB is transmitted through the air when coughing (52 percent for women and 46 percent for men).
Self-reporting TB infection. Less than 1 percent of women and 1 percent of men reported that they had been told by a doctor or a health professional that they had TB in the five years preceding the survey. Differentials across subgroups of respondents were small.
Stigma and Discrimination Associated with TB. Six in ten women and men who have heard of TB say they are willing to work with someone who has previously been treated for TB.
In the 2003 NDHS, household respondents were interview on their knowledge, practice, and attitudes toward health.
Knowledge of dengue fever. Results of the 2003 NDHS show that effective ways to prevent dengue fever are well known in the Philippines. More than two-third of household respondents reported that removing mosquito breeding places is a way to avoid dengue.
Knowledge of leprosy. About three in four household respondents (76 percent) have heard of leprosy. However, knowledge of the mode of transmission, contact with leprosy patient and skin-to-skin transmission, were correctly identified by only 31 and 28 percent of household respondents, respectively. A considerable proportion (26 percent) of respondents did not know how leprosy spreads from one person to another.
Knowledge of malaria. Nine in ten household respondents have heard of malaria, and 61 percent of them are right in saying that a mosquito bite is the major means of transmission.
Knowledge of cancer. Survey results show that 94 percent of household respondents are aware of cancer. Of those, 35 percent mentioned that the most obvious symptom of cancer is the presence of a lump or mass in any part of a person's body.
Diabetes. Almost all Filipino households (95 percent) have heard of diabetes. Awareness of this disease is high in all regions (86 percent in CAR to 98 percent in Western Visayas).
In the 2003 NDHS, household respondents were asked whether they or anyone in the household were members of Philippine Health Insurance Corporation (PhilHealth) and, if so, what type of members they were. Thirty percent of household respondents in the 2003 NDHS reported having at least one member in their household with PhilHealth membership. The largest proportion (43 percent) of PhilHealth members are employed in privately owned businesses or establishments, followed by government employees (27 percent). Individual/voluntary payers and indigents compose smaller percentages (15 and 11 percent, respectively), while overseas Filipino workers (OFW) and nonpaying members compose the smallest percentage (2 percent each).
DOH continues to promote locally produced herbs with scientifically proven medicinal uses through its Traditional Medicine Program. Then 2003 NDHS investigated the familiarity of Filipino households with these herbal medicines and their medicinal uses. The most popular herbal medicines are bayabas (guava, 98 percent), bawang (garlic, 92 percent), and amplalaya (bitter gourd, 88 percent).
In the 2003 NDHS, respondent were asked if a member of their household visited any health facility in the six months preceding the survey. More than half (57 percent) of the households utilized a health facility. Barangay health station, which are public health facilities operating at the grassroots level, are the most utilized health facilities (22 percent each).
Childhood Mortality. The infant mortality rate in the Philippines has declined from 34 deaths per 1,000 live births in 1990 to 29 deaths in 2000. At current mortality levels, 40 of every 1,000 children born in the Philippines die before the fifth birthday.
Mortality levels in urban areas are much lower than those in the rural areas (24 deaths per 1,000 live births compared with 36 deaths per 1,000 births). Childhood mortality is inversely related to the mother's education level and wealth status. The IMR for children whose mother have no education is 65 deaths per 1,000 live births compared with 15 deaths per 1,000 live births for children whose mother have college or higher education. The IMR is higher than the national average in seven regions: MIMAROPA, Western Visayas, Eastern Visayas, Northern Mindanao, Davao, Caraga and ARMM.